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Original Article |
1 Department of Surgery, Radboud University Nijmegen Medical Center (MC), Nijmegen, The Netherlands
2 Department of Epidemiology and Biostatistics, Radboud University Nijmegen, Nijmegen, The Netherlands
3 Department of Pathology, Radboud University Nijmegen MC, Nijmegen, The Netherlands
4 Department of Pathology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
5 Department of Pathology, Viecuri MC, Venlo, The Netherlands
6 Department of Pathology, Rijnstate Hospital, Arnhem, The Netherlands
7 Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
8 Department of Surgery, Viecuri MC, Venlo, The Netherlands
9 Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
10 Department of Medical Oncology, Radboud University Nijmegen MC, Nijmegen, The Netherlands
11 Department of Medical Oncology, University Hospital Maastricht, P.O. Box 5800, NL-6202 AZ, Maastricht, The Netherlands
Correspondence: Address correspondence and reprint requests to: V. C. G. Tjan-Heijnen, MD, PhD; E-mail: V.Tjan{at}sint.azm.nl
Background: In this multi-institutional prospective study, we evaluated whether we could identify risk factors predictive for non-sentinel lymph node (non-SN) metastases in breast cancer patients with a positive sentinel lymph node (SN).
Methods: In this multi-institutional study, 541 eligible breast cancer patients were included prospectively.
Results: The occurrence of non-SN metastases was related to the size of the SN metastasis (P = .02), primary tumor size (P = .001), and lymphovascular invasion (P = .07). The adjusted odds ratio was 3.1 for SN micro-metastasis compared with SN isolated tumor cells, 4.0 for SN macro-metastasis versus SN isolated tumor cells, 3.1 for tumor size (>3.0 cm compared with 
3.0 cm), and 2.0 for lymphovascular invasion (yes versus no). There were no positive non-SNs when the primary tumor size was 1.0 cm (n = 24) [95% confidence interval (95% CI) 0%–14.0%]. The proportion of positive non-SNs ranged in a prognostic logistic regression model from 9.7% (95% CI 4.0%–23.0%) for patients with SN isolated tumor cells, tumor size of 1.1–3.0 cm, and without vessel invasion, to 72.6% (95% CI 47.0%–89.0%) for patients with SN macro-metastasis, tumor size >3.0 cm, and with vessel invasion.
Conclusion: We identified three predictive factors for non-SN metastases in breast cancer patients with a positive SN: size of the SN metastasis; primary tumor size; and vessel invasion. We were not able to identify a specific group of patients with a positive SN in whom the risk for non-SN metastases was less than 5%.
Key Words: Breast cancer • Sentinel lymph node • Micro-metastasis • Non-sentinel lymph node metastasis • Risk factors
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